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R.e strict- ed 











ill 


1 




NAVY DBPAR'I'MB^T 



a diciest of titrtelij inform a f i on. 



EDITORS 



Captain W. W. Hall, (mc) u. s. n. 
CoMDR. F. R. Bailey, (mc) u. s, n. r. 



Vol. 3 



Friday, March 31, 1944 



No. 7 



TABLE QF CONTENTS 



Hospitalitis ........... ' 1 

Protein and Bed Sores 6 

Source of Urinary Ammonia — • 6 

Gas Gangrene, X-Ray Therapy 7 

D.D.T. 8 

Treatment of Pyorrhea 10 

Fulminating Meningococcemia 10 

Ainav #47 11 



Glycols and Floor Oils 12 

Glycols and Humidity 12 

Navy V-12 Programs 13 

Quinidine, Restrictions in Use. 13 

Giemsa Stain, Requests for 14 

Wellcome Medal and Prize 14 

Public Health Foreign Report..,,....15 
Alnav #50 16 



Form Letters : 

Medical Stores, Solicitation and Acceptance of...,. BuMed..... 17 

Coast Guard Personnel ~ Medical and Hospital Care BuMed .....19 

Human Plasma BuMed 23 

Dysenteries, Diagnosis and Treatment. .BuMed 24 

HOSPITALITIS : A disease which affected a large number of persons during 
and following the last world war. It simulates compensationitis but is not 
identical with it. 

Etiology : Unaccustomed leisure, separation from the demands of service 
with its duties, routines, training and responsibilities. Absence of the usual 
incentives to work, such as fear of hunger, thirst, sickness and poverty. The 
luUirig effect of having food, shelter, clothing, recreation, medical care, etc., 
furnished without the necessity of working to earn enough to provide for these 
needs. The sense of security for the future based upon the knowledge of the 
nation's traditional attitude toward the veteran of any of its wars. Delays in 
the matter of reaching a definite opinion as to what road a given patient is to 



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take - return to full duty, return to limited duty, transfer to veteran's hospital 
or discharge to civil life. Delay in the physician's clearly stating to the patient 
what disposition will probably be made of him so that he can be making plans for 
his future instead of drifting in a haze of uncertainty. Delays in^ Washington 
while survey papers are being processed in the Bureaus. Delays in beginning 
real vocational rehabilitation fitted to the patient's disability as soon as he is 
up and about. Lack of knowledge on the part of the patient that leisure to be 
of value must alternate with work or employment lest it become a poison in- 
stead of a boon. Lack of knowledge on the patient's part that only through pro- 
ductive work or through effort expended in service to self or to others, or in 
pursuit of a hobby, an idea or an ideal, can the exhilaration of accomplishment 
be produced in sufficient quantity to combat the destructive effect of idleness 
upon the body, mind and soul. 

Predisposing Factors: Heredity often plays a major role; also the persist- 
ence, into adult years, of childhood and adolescent conduct patterns, as well as 
insufficient schooling and lack of a civilian vocation to which the patient desires 
to return. The emotionally unstable and those who were maladjusted to civil 
life prior to entering the service are more susceptible than others and probably 
less amenable to prevention or treatment. 

Incidence is high in hospitals but seldom affects doctors, nurses and other 
persons engaged in the care of the sick while so employed. The disease spreads 
more rapidly in wards than in S.O.Q. 

Communicabilitv is high in naval hospitals unless active preventive measures 
are instituted early, with adequate segregation of non-immunes and early and 
effective treatment of incipient cases. 

Incubation Period: This is short on occasions, but generally extends to the 
time when the patient is up and about and has had his first few liberties with 
plenty of unoccupied leisure in which to "chew the fat" with his buddies in and 
out of the hospital. 

Iniection: Hospitalitis is transmitted partly by word of mouth and partly 
by precept and example. 

Immunity : Many are naturally immune. However, too intimate or too pro- 
longed contact with acute and chronic cases in hospital wards and rooms may 
overwhelm natural immunity. 

Course: Beginning as a mild and in many instances a preventable condi- 
tion, it steadily proceeds toward a chronicity that is very difficult to alter. The 
desire for compensation increases; the feeling that the government owes the 
patient a living wage for the war services performed becomes fixed, not alone 
in the mind of the patient but in the minds of family, relatives, Legionnaires, 
Congressmen and the public in general. 

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Sequelae persist for years. Admissions and discharges to and from hos- 
pitals alternate at irregular intervals. Insurance premiums are not kept paid 
up. Pensions are spent foolishly. Vocational rehabilitation is abandoned just 
when it seems to be succeeding. Employrnent when accepted becomes irregular. 
Periods between jobs grow longer. Applications for increases in pension are 
made with ever increasing insistence. In the later stages begging, selling pen- 
cils with red, white and blue markings, street singing and other forms of a 
decadent exhibitionism appear. 

Complications are many and are provided by the patient's family situation, 
his marital affairs, those with whom in his leisure he comes to associate, Con- 
gressional reflection of the national attitude that "nothing is too good" for the 
returning soldier or sailor, laws which give a higher compensation to the hos- 
pitalized than to those struggling toward rehabilitation outside the hospitals. 

Prognosis , while bad for the psychoneurotic, the ignorant, the inadequate, 
the maladjusted, is good for patients who are kept away from idleness. 

Duration : Unless prevented, or subjected to early effective treatment, hos- 
pitalitis will continue for life. Death is almost always caused by a super- ■ 
imposed condition rather than by the disease itself. 

Prevention, to be effective, should begin as soon as the patient is able to 
sit up in bed. It must be of such a nature as to combat the desire for every- 
day-early liberty. Vocational recreation should begin early and be supplanted 
by vocational rehabilitation. The probable degree of residual disability should 
be the guide to the vocation toward which the patient's attention should be directed 
and in which his interest should be enlisted. Occupation of mind and hand will 
combat the evils of idleness. At an early date after the patient is out of bed he 
should be taken away from daily contact with doctors and nurses. His daily 
supervision and direction should be in charge of vocational workers, controlled 
at a distance by medical personnel. 

Treatment : In a few cases speedy cure may be brought about by drastic 
measures such as removal of all financial support, the whip of hunger, thirst, 
exposure to cold and discomfort without hope of finding sympathetic assistance 
in any form other than a job fitted to the degree of disability. The British have 
had considerable success with such methods. They cannot be as freely used in 
the United States. To develop a less drastic and more successful treatment 
there should be an understanding' of the pathology so far as it has been determined. 

Pathology: We know that rest in bed, immobilization, medication, separa- 
tion from physical exercise, and lack of employment or occupation will adversely 
affect the vasomotor system. Blood pressure and pulse changes occur. There 
are loss of strength and endurance, loss of muscle tone with reduced ability to 
perform mental and physical work. The underlying pathology may in a word be 
called bodily hypofunction. 



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Onset is gradual as a rule but may be sudden, especially if the patient has 
been unhappy in the service or for one reason or another has been unable to ad- 
just to service life. 

Chief Complaint is an aversion to work in the ward or elsewhere in the hos- 
pital or hospital grounds. Subconsciously there soon develops an awareness of 
pensions, bonuses and other benefits to which the patient may become entitled 
upon return to veteran or civilian status. 

Symptoms and Signs : In the early stages there is an increasing desire for 
liberty. This is accompanied by an attitude of watching the clock after the noon 
meal, often from a recumbent position on a convalescent bed. Later on, the 
desire for liberty tends to become less acute only to flare up acutely if liberty 
be denied. Requests for special liberty supported by flimsy reasons may suggest 
the presence of this disease and should receive careful scrutiny. Conduct in 
the hospital is generally good unless while on liberty the habit of absorbing 
liquor in too great quantity or too steadily becomes fixed. As a rule these pa- 
tients stand sharply at attention at ward rounds, and they are polite and military 
in speech and manner in the presence of a medical officer. Their attitude to- 
ward nurses and hospital corpsmen may be less cooperative, especially if 
asked to help in a cleaning or other detail after the medical officer has left the 
ward. 

As time passes, the idea of a return to active duty becomes more and more 
distasteful, and if sent to duty, relapse is not uncommon. Physiotherapy, almost 
any medication, or a diagnostic or surgical procedure will be accepted without 
demur. Chronic cases in the last war would have operations upon the appendix, 
the gall bladder or the stomach. Then just when apparently fit for discharge 
from the hospital, a need would appear to remove the tonsils or to correct a long 
forgotten deviation of the nasal septum. After that a chronic prostatitis, a piloni- 
dal dimple, an ingrowing toenail or a long deferred urge for circumcision will 
be subjected to enthusiastic medical and surgi'cal observation, recording and 
care . 

A gain in weight is the rule. The call to "chow" is never overlooked even 
when lack of appetite is complained of. Back rest is important during the day 
but seems less important during overnight liberty. The facial expression is 
calm but may take on an almost combative appearance if light work in the hos- 
pital is suggested too insistently. 

Vague and shifting pains, aches and other symptoms tend to subside when 
the patient is told a medical survey is to be held, and they may almost completely 
disappear if three months' additional treatment or extended convalescent leave 
is granted. ' 

Recognition is easier for those who, foil-owing the last war, had charge of 
Veterans' Administration patients, than it is for younger medical officers or 



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for civilian physicians unless they are familiar with the problems of industrial 
surgery or with court trials for accident compensation claims. 

Differential Diagnosis: The condition is almost never primary. It accom- 
panies the history, symptoms and laboratory, X-ray and physical findings o f 
the injury or disease foi* which the patient was admitted to the hospital. As the 
admission disease or injury progresses toward cure or toward residual disa- 
bility, hospitalitis fastens itself upon the patient as a parasitic growth when the 
environment is favorable. 

Treatment of Convalescence bv Reconditioning and Phvsical Fitness Exer- 
cises: The Committee on Convalescence and Rehabilitation of the National Re- 
search Council (quoted in the January 21, 1944, number of the Bumed News 
Letter) make it clear that in their opinion convalescence in a military hospital 
needs treatment of a very special sort and by personnel other than medical if 
the dangers of prolonged and perhaps ^chronic body hypof unction are to be 
prevented. 

Management , to be effective, should begin very early. The ward medical 

officer who knows that bodily h3rp of unction is dependent not only on the morbid 
process which brings the patient under his care but also upon unaccustomed rest 
and idleness, should begin the rehabilitation of his patient before the primary 
morbid process has run its course. The Chief of Service who knows the early- 
signs of hospitalitis should tufee Mips to prevent its insidious onset and progress 
toward chronicity. 

At the earliest possible moment an estimate of the probable degree of disa- 
bility both temporary and permanent should 'be made and explained to the patient 
quite clearly. Thus he can be helped to face reality. After this he should be 
reassured and led toward a belief that whatever his disability may be, he can 
find a way to overcome it. 

Nothing is more harmful to a patient, long resident in the hospital, than lei- 
sure. All should be given jobs , beginning with tasks that can be undertaken in 
bed, continuing with ward duties, then on to vocational therapy, to vocational 
rehabilitation, then a real jdh. Vocational retrainir^ has been associated with 
Veterans' Administration supervision. It should not wait that long. It should 
begin as soon as the patient has a hand that is free, a mind that can receive 
ideas. He should be led to think in terms of living a normal life with others. 
Faith in his ability to compete for all that is good in life should be fostered, 
not allowed to die in a bog of dependence on pensions, bonuses, disability allow- 
ances, self-pity, idleness, boredom aaid the asocial life of some modification 
of the old soldier's home. 

Doctors serving in naval hospitals have a wonderful opportunity and a grave 
responsibility. The training and rehabilitation of their patients should begin 
long before patients have a chance to succumb to hospitalitis. In naval hospitals 

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are medical social workers, recreational facilities, Grey Ladies, librarians, 
athletic and welfare officers, masters-at-arms, doctors, nurses, hospital 
corpsmen. Do we now need specially trained vocational counsellors, physical 
education instructors to lead our patients back from the dangers of too much 
leisure to the contentment of fully occupied lives ? If the medical officer i s 
not sufficiently aware of this problem to institute preventive and early cura- 
tive measures, the Veterans' Administration facilities will have to assume a 
larger burden than necessary in the post-war era. 

Plan for Rehabilitation in Hospital: As soon as the patient is able to use 
hand or brain, put him in contact with recreational or vocational therapy. As 
soon as he is out of bed, put him to work in the ward or in the hospital grounds. 
Protect him from the dangers of idleness. As soon as he is up and about, tell 
him whether he may expect to return to active duty in the service or to be dis- 
charged to civil life. If later on such a decision must be reversed, keep him 
posted so that he may remain adjusted to his post-hospital status. Before he 
is able to go on a weekend liberty, put him in contact with the vocational coun- 
sellor. Record the vocational retraining which he needs and recheck the vo- 
cational decision with the Chief of Service. Remove ambulant patients from 
daily ward routines and from the daily supervision of medical officers. If possi- 
ble, establish a barracks routine with medical care available, but with the bar- 
racks in charge of vocational teachers. Substitute for daily medical officer con- 
tact, daily contact with an occupation. (Contributed by Captain George F. Cottle, 
(MC), USN (Ret.)) 

'T* 'X* 

Protein and Bed Sores : Mulholland et al. in the Annals of Surgery, Decem- 
ber 1943, reported that of 35 patients with bed sores, 29 had plasma proteins 
below 6.0 Gm. per 100 c.c. To explore the possibility of a relationship between 
bed sores and hypoproteinemia, two patients were placed on high protein diets. 
Prompt healing of the ulcers resulted. 

Under controlled conditions eight patients with decubitus ulcer were then 
studied. All of them had shown no improvement in the sores while on the regu- 
lar ward diet. When dietary protein was inadequate, the addition of vitamins to 
the diet did not help. However, when placed on diets sufficiently high in protein 
to achieve positive nitrogen equilibrium and restoration to normal of serum pro- 
tein values, these patients improved with respect to their weight and general 
condition, and their bed sores promptly healed. (M.T.) 

The Source of Urinary Animonia: The kidney, by excreting acid radicals 
in combination with ammonia instead of with cations such as sodium and potas- 
sium, helps to conserve the fixed base of the body. 



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The source of urinary ammonia has been investigated frequently. The 
view expressed in 1921 by Nash and Benedict that urea was the most probable 
precursor of ammonia in the kidney persisted for years despite the absence of 
the enzyme urease from the kidney. Krebs, in 1933, demonstrated the ability 
of the kidney to deaminize amino acids, and the suggestion was made that 
amino acids were the most important sources of urinary ammonia. 

The origin of urinary ammonia appears at last to have been determined by 
Van Slyke and his associates. These investigators experimented on dogs with 
explanted kidneys and determined accurately the amounts of various substances 
removed from the blood by the kidney in given intervals of time. All of the urea 
removed from the blood was excreted as such in the urine. Under no condition 
was it possible to demonstrate a conversion of urea nitrogen to ammonia nitrogen. 
Alpha-amino acid nitrogen was sometimes removed from the blood by the kidneys, 
but the amount was inadequate to account for the ammonia excreted. The amide 
of glutamic acid, glutamine . which only recently was demonstrated to be present 
in blood, serves apparently as the precursor for the bulk of urinary ammonia . 
The administration of glutamine to a dog in which acidosis had been produced by 
the administration of hydrochloric acid definitely increased the excretion of 
ammonia. Th^ excretion of ammonia could furthermore be depressed by changing 
from the hydrochloric acid acidosis to bicarbonate alkalosis, and with this 
change there was an accompanying decrease in the amount of glutamine removed 
from renal blood. • 

From the foregoing, it appears that glutamine performs an important physi- 
ologic role as the precursor of the major portion of urinary ammonia in a mam- 
mal. Amino acids may possibly be a minor source, but urea is definitely not 
the precursor of ammonia in urine. Elimination of ammonia by the kidneys does, 
of course, decrease the amount of nitrogen available for synthesis of urea by 
the liver. This relationship led in the past to the erroneous conception that urea 
was the precursor of urinary ammonia. (Editorial, J.A.M.A., Feb. 26, '44.) 

X-Rav Therapy in Management of Gas Gangrene : At the request of the 
Office of the Surgeon General of the Army, the Subcommittee on Radiology of 
the Division of Medical Sciences of the National Research Council discussed 
X-ray therapy in the management of cases of gas gangrene at its meeting on 
February 10, 1944. The following resolution was unanimously adopted: 

"The place of X-ray therapy in the management of cases of gas gangrene 
has been a concern of this Committee for several years. In the future as in 
the past, the Committee will continue to concern itself with this problem. The 
present opinion of the Committee, based upon continuing study of the work of 
many investigators, is that, up to the present time, the effectiveness of X-ray 
in the treatment of gas gsmgrene has not been established. For this reason, the 
use, of X-ray therapy in gas gangrene is still experimental." 

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This action of the Subcommittee on Radiology has been approved by the 
Chairman of the Committee on Surgery and also by the National Research 
Council Subcommittee on Infected Wounds and Burns. 

* * 

■ The mortality rate in gas gangrene is high. There are therapeutic meas- 
ures of proved value which help to lower the mortality. These include (1) ade- 
quate debridement of wounds, with particular reference to devitalized muscle 
or muscle of which the blood supply has been compromised, (2) radical surgery 
when the infection is well established and is spreading, (3) gas gangrene anti- 
toxin, (4) the oral and parenteral use of sulfonamides, in an attempt to make 
healthy tissue more resistant to infection, (5) penicillin, and (6) transfusion. 

Further studies of the relative effectiveness of other methods of proved 
value and of radiotherapy must be made in experimental animals and man. 
However, gas gangrene in the military casualty is a condition not for experi- 
mentation but for enthusiastic therapy with weapons of known value. When 
roentgen therapy is used, it should be "in addition." 

D^D.T . was developed under the name of "Gesarol" by J. R. Geigy, Inc., of 
Basel, Switzerland. It was first used as an insecticide in connection with the 
cultivation of fruits and vegetables. Preliminary studies which have been done 
by the U. S. Department of Agriculture indicate that D.D.T. will probably revo- 
lutionize the practice of insect control. The substance gains entrance into the 
insect's body through the chemotactic sensorial organs located in the tips of 
the tarsi. Lethal action is attained through irritation and paralysis of the 
nervous system. When D.D.T. is applied to various surfaces such as walls, 
screening, tents, etc., it usually retains insecticidal activity for several weeks. 
Dosages which have been found to be effective against insects are non-toxic to 
humans. There is apparently no danger to man from Inhalation if reasonable 
precautions are taken. Amounts in excess of ordinary usage may be toxic b y 
mouth. Oily solutions are absorbed from the skin, a danger to be avoided among 
personnel working with D.D.T. solutions. 

Present Status of D.D.T.: It must be clearly understood that D.D.T. is just ' 
now emerging from the experimental stage. Plans are being made for the large- 
scale production of this new insecticide; but the contingencies of war, plus the 
difficulties encountered in the manufacture of a chemical so difficult of synthe- 
sis, have prevented its availability for general use at the present time. Limited 
quantities now available to the Navy are used for experimentation and for the 
manufacture of louse powder (Bumed News Letter, Vol. 3, No. 2.). It is expected 
that when the production of D.D.T. is increased, it will first be supplied to troops 
in forward areas for use against mosquitoes. Detailed instructions as to the 
procurement and use of D.D.T. will be published at a later date. 



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Extensive experiments, involving both the fundamental and the practical 
aspects of D.D,T. have been done by the U. S. Department of Agriculture. The 
Army and the Navy have collaborated on the various problems which pertain to 
the armed services. Some of the experiments, which are still continuing, have 
shown the following: 

(a) Adult mosquitoes are effectively controlled by using D.D.T. in aerosol 
bombs, dusts and various sprays. The insolubility of D.D.T. in water necessi- 
tates the employment of special solvents and emulsions for its use as .a spray. ' 
As well as killing mosquitoes in the air, it is also effective against larvae after 
settling to water surfaces. In one experiment, a liter of 5 per cent D.D.T. in 
kerosene distributed over one acre reduced adult mosquito population by 99 per 
cent within one hour. Thirty-six hours later there were still practically no 
mosquitoes in the area. 

(b) Mosquito larvae have been completely controlled by 0.1 pound of D.D.T. 
per acre; this amount was dispersed in a 5 per cent oil solution. This dosage 
required 1 quart of oil per acre, whereas oil as ordinarily used in larval con- 
trol requires several gallons per acre. One pound of D.D.T. per acre, distributed 
in lime-talc dust, has given larval control for two or more weeks, but this method 
is too easily influenced by the weather conditions. 

(c) Flies: Practical experiments have shown that a one per cent solution 
of D.D.T. sprayed in stables gave complete fly control for 36 days. Screening 
sprayed with a 5 per cent solution retained a lethal effect against flies for 38 
days. Care must be used in galleys to be sure tnat the insecticide does not fall 
on exposed foods. 

(d) Bedbugs: The prolonged residual action of D.D.T. makes it ideal for 
use against bedbugs. At the beginning of an experiment conducted in an Army 
barracks, 57.8 per cent of 2,147 beds were found to be infested with bedbugs. 
Each bed was treated with 213 c.c. of a 5 per cent D.D.T. solution, and all bed- 
bugs were killed. A month later, at the time of reporting, there were still no 
live bedbugs found. 

Ce) Cockroaches: One-half pound of D.D.T. in talc was dusted throughout 
a store heavily infested with roaches. The insects shortly appeared sick and 
all died in 24 hours. In addition to this effect on cockroaches, there was a 
marked effect on flies as shown by the fact that spraying against flies was not 
necessary for two weeks; previously, standard fly spray had been required 
several times daily. (F.T.N.) 



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The Treatment of Pyorrhea: A study of the treatment of paradentosis 
(pyorrhea alveoiaris) has been made at the Naval Medical Center, Bethesda, 
Maryland. In eleven cases of paradentosis, ranging from mild to severe, the 
most favorable results occurred in those where the patients were most dili- 
gent in maintaining good oral hygiene following the scaling and polishing of 
the teeth. 

As recorded by direct measurements before and after treatment, reduction 
in depth of the gingival pockets was more marked following medication- with 8 
per cent zinc chloride than with micraform sulfathiazole. This reduction in 
depth was apparently due to the contraction of the pocket wall and not to re- 
attachment of the tissue to the root. (J.S.R.; J. L.B.) 

4^ ^ ^ ^ 4^ ^ 

Fulminating Meningococcic Infections: When cerebrospinal fever is en- 
demic, an occasional case may be encountered which presents the clinical picture 
of ■ fulminating meningococcemia. Patients with this syndrome'are easily recog- 
nizable. They are usually in a state of circulatory failure, with thready or ab- 
sent pulse and marked arterial hypotension. The veins are usually collapsed. 
Marked hyperpyrexia is the rule. The most striking finding is a rash, entirely 
different from the usual rash of meningococcemia in that it is purpuric in charac- 
ter and tends to involve not only the extremities and trunk, but the conjunctivae 
and other mucous membranes as well. The condition of the patient deteriorates 
with alarming rapidity. The respiratory rate increases, the purpuric areas 
take on a deep purple hue and rapidly the cyanosis becomes generalized. Con- 
sciousness is more often preserved almost to the end; less often the patient 
will lapse into coma as he develops circulatory failure. Examination of the 
blood will usually reveal meningococci in the blood culture, occasionally on 
direct smear. Examination of the spinal fluid often reveals nothing abnormal. 
At autopsy about half of the cases are found to have hemorrhages (often massive) 
into one or both suprarenal glands. 

This condition has been much discussed in the recent literature. When 
suprarenal hemorrhage is present, it is often called the Waterhouse- 
Friederichsen syndrome. So successful has been sulfonamide treatment of 
the usual meningococcus meningitis and meningococcemia that the high mor- 
tality in these fulminating cases stands out in sharp contrast. Fatalities were 
the rule. In the last two years, however, coincidently at least with heroic 
treatment, an increasing number of survivals has been reported. 

Two important unanswered questions regarding fulminating meningococcemia 
are: (1) Is the circulatory collapse due entirely to the overwhelming toxemia, 
or does suprarenal insufficiency, at least in some cases, play a role; and (2) 
do patients who have massive adrenal hemorrhage ever recover ? These 
questions cannot be answered because (a) patients who recover often present 



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before therapy a clinical picture identical with that of those who die and are 
found to have suprarenal hemorrhage, and (b) among those who succumb to 
the disease the clinical picture in the terminal stage is often identical whether 
or not adrenal hemorrhage is later found at necropsy. 

The majority of patients with this condition who have recovered have been 
treated with approximately the following regime: 

1. Continuous infusion of saline and glucose, maintained over a period of 
24 to 48 hours or more. 

2. Immediate ^d intensive intravenous therapy with sodium sulfadiazine. 

3. Transfusions of whole blood. 

4. Meningococcus antitoxin. 

5. Adrenal cortex substance in large doses. 

There can be no question of the value of procedures 1,2, and 3. Doubts 
have recently been raised as to the potency of our meningococcus antitoxin. 
Possibly it is of no value in these cases. However, there is no other situation 
in wh'ich a potent antitoxin is more urgently needed than in this, and perhaps, 
if adequate tests for sensitivity are negative, it is wiser to give the antitoxin 
if available in the hope that it may do some good. Whether or not the adrenal 
cortex extract is of value we cannot be certain. Bilateral adrenalectomy in 
the experimental animal causes no such fulminating development of symptoms 
of adrenal insufficiency. It is unlikely that the low values" for serum sodium 
reported in this condition can result so quickly from withdrawal of the adrenal 
sterols which prevent the renal tubules from wasting water and sodium. How- 
ever, on the chance that suprarenal substitution therapy may help, it should be 
tried. The condition of these patients is desperate. The tide has apparently 
been turned in certain cases by the type of therapy mentioned above. Very few 
who have seen such cases would have the courage, in the present state of our 
knowledge, to withhold any of it intentionally. 

Because sulfonamides are bacteriostatic rather than bactericidal in their 
action, a lag of a few hours may exist between the administration of sulfadia- 
zine and the time when it begins to be effective, and often death will occur during 
this time. Penicillin administered by vein along with the initial doses of sulfa- 
diazine may be found to exert a quicker action. Full utilization of such combined 
therapy is surely justified. 

ALNAV #47: All frank rheumatic fever patients beyond continental limits 
of US to be transferred preferably by air transport to nearest naval hospital 
within continental limits at earliest date compatible with the state of their dis- 
ease X includes officer and enlisted patients Navy and Marine Corps. . 



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Studies of Glycols and Floor Oiling in the Control of Air- B orne Bacteria: 
Field investigations conducted in a naval hospital ward to evaluate propylene 
glycol and trlethylene glycol vapors and the oil treatment of floors as to their 
efficacy in reducing the total bacterial and hemolytic streptococcus counts of 
the air: Detailed observations were made on all ward routines to correlate 
various types of activity in the ward with the resultant data. It was found that 
such occurrences as sweeping, bed- making or the activity incident to morning 
and meal-time routine caused marked rises in both total bacterial and strepto- 
coccal counts. Neither propylene glycol nor triethylene glycol vapor in con- 
centrations up to saturation produced significant reduction of bacterial levels 
under such peak conditions. 

Swabbing floors with water, propylene glycol, propylene -glycol -water mix- 
tures, or with a light oil held down considerable dust. Dust was the major 
source of rises in counts. However, only oil was found to have the character- 
istics necessary to produce a lasting effect. One application of oil held all 
counts, except those following bed-making, to "quiet" levels for over a week 
and was partially effective after two weeks. The second application was com- 
pletely effective for over two weeks. 

Routine application of floor oils is recommended as a measure to reduce 
cross-infections. (Quarterly Progress Report: Naval Medical Research Unit 
#1, Jan. 6, '44.) 

****** 

T^ffect of Temperature. Humidity and Glycol Vapors on Air-Born e Organ- 
isms : A dynamic system, consisting essentially of a dust-free stream of air 
moving through a long glass tube at a constant velocity, enabled rapid estima- 
tions of death rates of air-borne bacteria under rigidly defined physical condi- 
tions of temperature and humidity. A test organism, S. pullorum. was atomized 
from water into the system, and known concentrations of propylene glycol or 
triethylene glycol vapors could then be introduced. Increases in bacterial death 
rates produced by the glycols were determined by comparison with normal death 
rates under similar conditions. 

Changes in relative humidity between forty and sixty per cent produced 
little change in death rate; however, a low relative humidity (15 per cent) greatly 
increased survival time, while high relative humidity (80 per cent) manifested 
the opposite effect. 

A rise in temperature from 28°C. to 37°C, progressively decreased the 
survival time with every increase in humidity tested. The combined effects of 
increasing both temperature and humidity appeared to be additive. 

The effectiveness of glycol vapors increased as their concentration ap- 
proached the saturation capacity of the air. The efficiency of a given glycol - 
concentration decreased as the temperature was raised from 28^0 . to SV^C. 



- 12 - 



and as the relative humidity deviated from approximately 45 per cent. The 

I normal death rate at 80 per cent relative humidity was so high that' any effect 

of glycol vapors was masked. At 15 per cent relative humidity the normal 
death rate was very low, and was not increased even in the presence of high 
concent2*atioiis of glycol vapors. The concentration of propylene glycol required ■ 
to produce a given reduction in death rate was more than aQOrtimes that of ■ 
triethylene glycol. (Quarterly Progress Report: Naval Medieal Research 
" Unit #1, Jan. 6, '44.) ' . . , 



The Navy V- 12 Program : The recent curtailment of the Army's Special- 
ized Training Program has raised the question of whether or not the Navy is 
contemplating corresponding changes in its V-12 program. The following pas- 
sage is quoted from an editorial appearing in the Journal of the American _ . 
Medical Association of February 26, 1944: ''Vice Admiral Randall Jacobs, 
Chief of Naval Personnel, states in a message to The Journal that the Bureau 
of Naval Personnel has recently received many inquiries concerning reports 
that the Navy college program may be discontinued. 'All inquirers have been . 

♦ ' advised that the Navy Department has no plans to discontinue this program. 

« The U. S. Navy is still expanding. The urgent need for technically trained 

< young officers continues, and the colleges and universities participating in 
the ^-12 program are doing a splendid job of producing such officers. While 
changing wartime conditions may, from time to time, necessitate revision in 

^ the quotas for the program in order to conform with the needs of the Service, 
the Navy does not contemplate discontinuance of the program.' " 

****** 

' Restrictions in the Use of Quinidine : The Committee on Drugs ^d Medical 
Supplies of the National- Research Council at its meeting on February 9, 1944, 
made certain recommendations to the War Production Board relative to p r o - 
cedures made necessary by the present short supply of quinidine. The last 
paragraph states the special recommendations of the Committee with regard 
to the Army and Navy. The full report follows: 

"It is recommended that quinidine be limited to the treatment of heart 
disease on prescription of a person licensed to practice medicine and surgery 
in the state. That this quinidine is to be used for the treatment of heart dis- 
use should be certified by the prescribing physician. 

"It is further recommended that quinidine should not 'be combined with 

other drugs and prepared fixed formulas. ^ 

. A f..1-t - 

■ '"Criteria for the use of quinidine during the period of shortage should be 
limited to: - - - - . ...... . ■ 



- 13 - 



Burned News Letter, Vol. 3, No. 7 



RESTRICTED 



1. Ventricular tachycardia diagnosed electrocardiograpMcally. 

2. Congestive heart failure that appears definitely to have been 
precipitated by the sudden onset of auricular fibrillation (if not adequately 
controlled by digitalis) . 

3. Persistent premature ventricular contractions in patients who 
have had acute coronary artery occlusion. 

4. Chronic disease of the heart associated with paroxysmal auricular 
fibrillation, paroxysmal auricular tachycardia or auricular flutter. 

5. A history of systemic embolization in a case of paroxysmal or 
established auricular fibrillation. 

''Prescription of quinidine should be limited to not more than fifty 3- grain 
tablets for any acute attack of arrhythmia fulfilling one of the foregoing cri- 
teria, and to not more than thirty 3-grain tablets per week for the purpose of 
maintaining sinus rhythm after quinidine has reestablished it." 

The Committee also asked that copies of this recommendation be sent to 
the Surgeons General of the Army and Navy with the hope that the present 
situation could be called to the attention of appropriate medical officers to 
avoid indiscriminate use of the drug in military hospitals. 

****** 

Request Giemsa Stair from N.M.S.D.': Numerous requests for Giemsa 
stain are being received at the Naval Medical School, Bethesda, Maryland. 
The following is quoted, in part, from the Burned News Letter, Vol. 2, No, 4, 
of August 20, 1943'. 

' ' Giemsa Stain : The Naval Medical Supply Depot has placed Giemsa stain 
on the Supply Table. Each 50 c.c. bottle of stain is packaged with a bottle of 
dry buffer salts and directions for use in staining both fixed thin blood films 
and unfixed thick blood drop preparations. 

''This item will be listed in the Supply Catalog as: No. S4-0156 STAIN, 
GIEMSA 50- cc bot (with 25- cc buffer salts)." (P.W.W.) 

,|c * * * * * 

The Sir Henrv Wellcome Medal and Prize Given bv th e Association of 
Milita-rv Surgeons: The competition is open to all medical department officers, 
former such officers, Acting Assistant and Contract Surgeons of the Army, 
Navy, Public Health Service, Organized Militia, Veterans' Administration, U.S. 
Volunteers, and the Reserves of the United States, commissioned officers of 
foreign military services, and all members of the Association, except that no 
person shall be eligible for a second award of this medal and prize. It should 
be understood that no paper previously published will be accepted. 



- 14 - 



. ^^^-•i^.i^v'.^, B^imfed News flatter ^ Vol. 3., No. 7--: -i RESTRICTEp 

•The award of 1944, a gold medal and a cash prize of $500, will be given 

for the paper selected by a committee of the Association's vice-presidents 
which presents the most useful original investipration in the field of military - 
medicine . The widest latitude is given for this competition, so that it may be 
open to all components of the membership of the Association. Appropriate 
subjects may be found in the theory and practice of medicine, surgery, den- 
tistry, veterinary medicine and sanitation. The material presented may be 
the result of laboratory work or of field experience. Certain weight will be 
given to the amount and quality of the original work involved, but relative 
v^tue to militarf^ maiiclne as a whole will be the determinittg' factor. 

Each competitor must furnish five copies of his competitive paper. Papers 
must not be signed with the true name of the writer, but are to be identified 
by a nom de plume or distinctive device. They must be forwarded to the Secre- 
tary of the Association of Military Surgeons of the United States, Army Medical 
Museum, Washington, D. C, so as to arrive at a date not later than August 31, 
1944, and must be accompanied by a sealed envelope marked on the outside 
With the fictitious name or device assumed by the writer and enclosing his true 
name, title and address.- The length of the essays is fixed between a maximum 
of 10,000 words and a minimum of 3,000 words. The envelope accompanying 
the winning essay or report will be opened by the Secretary of the Association 
and the name of the successful contestant announced by him. The winning essay 
or report becomes the property of the Association, and will be published in The 
Military Surgeon. Should the Board of Award see fit to designate any paper for 
"first honorable mention" the Executive Council may award the writer life 
membership in The Association of Military Surgeon, and his essay will also 
become the property @f>la^'A^>ciationf''^0^ Surg., Fife. *44^ 



Public Health Foreign Report: ■ .j---/:';.rC' .- 



Disease 


Place 


Date . ■ >- 


flumber of Cases 


Plague --' 


Madagascar ■" 


December *4S . • 


: ,-':n /I 4 (4 fatal) 




Morocco (Fr.) 


December '43 


3 




Ripiogilt (Northern) 


Jan. 1-8, '44 


1 (1 fi^) 


Smallpox 


Algeria 


Dec. 11-20, '43 


4i 






Jan. 11-20, '44 




Si?^. last; Africa 


Dec. 25, '43-Jm,:l,. 


'44 164 






Jan. 1-8, '44 


104 






Jan. 8-15, "44 


241 




Greece ■ 


Aug. l-Oct. 10, '43 


403 




Indochina 


Dec. 21-31, '43 


86 






Jan. 1-10, '44 


• ■ lie 



- 15 - 



Burned News Letter, Vol, 3, No. 7 RESTRICTED 



Public Health Foreign Report : (Cent.) 



Disease 
Smallpox 



Typhus Fever 



Yellow Fever 



Place ■ 




Date 


Number of Cases 


Morocco (Fr.) 


December '43 




162 






Peru, Lima 


Jan. 


15-22, '44 




14 






Senegal 


Nov. 


21-30, '43 




37 


(5 


fatal) 


Sudan (Fr.) 


Dec. 


21-31, '43 




101 


C4 


fatal) 

\ 


Algeria 


Dec. 


11-20, '43 




19 








Jan. 


11-20, '44 




39 






Arabia 


Jan. 


1-8, '44 




1 


(1 


fatal) 




Jan. 


8-15, '44 




7 


(2 


fatal) 


Greece 


Aug. 


21-Oct. 10, '43 




30 






Hungary 


Dec, 


18-25, '43 




61 








Dec. 


25, '43- Jan. 1, 


'44 


46 








Jan. 


2-22, '44 




160 






Morocco (Fr.) 


December '43 




114 






Netherlands 


Oct. 


31-Nov. 6, '43 




1 








Nov. 


20-27, '43 




2 






Rumania 


Nov. 


6-13, '43 




75 








Jan. 


8-15, '44 




443 








Jan. 


15-22, '44 




391 






Slovakia 


Dec. 


19-31, '43 




14 








Jan. 


1-8, '44 




30 






Spain 


Nov. 


. 7-27, '43 




46 








Nov. 


27-Dec. 4, '43 




9 







Cape Verde Islands, 
Praia 

Fr. Guinea, Dubreka Dec. 31, '43 

Dubreka 
Gold Coast 



Ivory Coast 



Dec. 
Jan. 
Dec. 
Dec. 
Dec. 
Dec. 
Dec. 



3 
4 
3 
7 
15 
17 
24 



(Pub. Health Rep., Feb. 18, '44.) 



, '43 
, '44 
, '43 
, '43 
, '43 
, '43 
, '43 



(case suspected 
unconfirmed) 

1 (suspected, 
fatal) 

1 (1 fatal) 

1 (suspected) 

1 (fatal) 



(fatal) 
(fatal) 
(suspected) 



1 (fatal) 



ALNAV #50 : All personnel destined for and personnel now stationed in 
Africa Europe and the Middle East whose health record contains no entry for 
smallpox vaccination during past six months shall be vaccinated at earliest 
practicable date. 

- 16 - • 



Burned Nems 



RESTRIDTEn 



fil i^J5S aiSd#WteltSv - - •n>Tori7; BUMED-T-RLJ 

A3-2/L24(011-41) 
Medical Stores, Solicitation and Acceptance 17 Feb 1944, ■ ... 
of From Civilian Agencies. 

(a) BuMed Itr JJ57/HJ(0l3-42), 4 Oct 1943; N. D. Bui, of 15 Oct 1943, 
R-1484. 

(b) SecTreasury Itr, 24 Nov 1942, to SecNav. 

(c) SecNav Itr JAG:J:H]M:amp, SO6-3013, 2 Jul 1943, to BuMed. 

1. The Bureau has been informed of several instances in which commanding 
officers and medical officers have requested and accepted medical stores from 
civilian agencies. Solicitation of services or material from civilian agencies or 
individuals is not approved, except as authorized by reference (a) . 

2. The Second War Powers Act, approved 27 March 1942, authorizes acceptance 
or rejection of voluntary donations by the Secretary of the Treasury, and speci- 
fies the conditions under which such gifts may be accepted and reports to be 
made. The Secretary of the Treasury has authorized the Secretary of the Navy 
to act for him in certain instances, reference Cb). SecNav has in turn delegated 
authority to accept donations of items of minor value to the Chief, BuMed, and 
required periodic reporting of donations accepted, reference (c). 

3. In view of the foregoing, donations of medical stores or other services and 
materials by civilian agencies or individuals may not be accepted by ships and 
stations except as authorized by reference (a) or otherwise specifically author- 
ized. Civilian agencies or indivldu^s desiring to donate medical stores to the 
Navy should be advised to communicate with the Bureau of Medicine and Surgery, 
stating the name of the prospective donor, a description of the items offered, 
the quantity, and the approximate value, — BuMed. Ross T. Mclntire. 

+ * 

(Reference (a) is reprinted herewith: ) 

To: All Ships and Stations. 

Subj; Acceptance by Medical Department of Red 
Gross Supplies and Services. 

1. In general the policy for acceptance by the Medical Department of Red Gross 
supplies and services is as set forth in section VI, appendix C, Manual of the 
Medical Department, as follows: 

"Medical and surgical supplies and equipment may be accepted from Red 
GroSiS; 3:gpmjsmti.ti¥ea 'Wjten authorized by the Bureau of Medicine and Surgery 



Subj; 
mist 



BUMED- Cr LET 
JJ57/HJ(013-42) 
4 Oct 1943 



- 17 - 



Burned News Letter, Vol, 3, No. 7 



RESTRICTED 



or in advance of such authority when an emergency exists. As a'rule no supplies 
shall be accepted from the Red Cross which can be obtained through regular 
Navy procedure. " 

2. It is not intended that the Red Cross shall duplicate or parallel the work of 
the Medical Department in the procurement and distribution of medical supplies. 
Standard medical supplies procured by the Red Cross will be held as a reserve 
to meet unforeseen emergencies or to supplement standard medical supplies in 
grave situations. In other words: 

(a) When time and other circumstances permit, Medical Department supplies 
and equipment shall be obtained through the regular naval medical supply channels. 

(b) In emergency, Medical Department activities may call on the Red Cross 
field directors or local Red Cross chapters for medical aid. - supplies and ser- 
vices, inclusive of nonstandard or less essential remedial supplies which cannot 
be obtained immediately through usual channels. 

' (c) Medical Department activities normally are expected to process their 
own dressings, bandages, etc., from materials obtained through the regular naval 
medical supply channels, except that activities such as ships fitting out may util- 
ize their commissioning outfit of surgical dressings to supply local Red Cross 
chapters for the preparation of surgical dressings for the particular ship. 

(d) Supplies of surgical dressings, bandages, etc., produced by the Red 
Cross are held for release through the commandants of the several naval districts. 
Requests from Medical Department activities for such dressings for emergency 
use or quickly to supplement stocks on hand should be made on the nearest dis- 
trict commandant. The commandants (district medical officers) are requested to 
review these requisitions and arrange with the Red Cross for issue or take such 
other action as may be indicated. 

3. Battle dressings (pack, abdominal; pad, combination; sponge, surgical) manu- 
factured by the American Red Cross are held for Navy use as follows: 

On order of Commandant, Twelfth Naval District: 

American Red Cross Warehouse, 1543 Mission St., San Francisco, Cal. 
American Red Cross Warehouse, Interstate Terminal Warehouse Co., 
24th and Wall Ave., Ogden, Utah. 
On order of Commandant, Third Naval District: 

American Red Cross Warehouse, 26 Exchange Place, Jersey City, N.J. 
• On order of Commandant, Sixth Naval District: 

Atlanta Chapter, American Red Cross, 850 Peachtree St., Altanta, 
Georgia. 

4. Except when specifically directed by BuMed or as authorized in paragraph 
2(c) of this letter, Medical Department activities will not issue Navy material for 
Red Cross processing. 



- 18 - 



. Bumed. Mews Letter.*. .¥aL 5* HQ .. 7 RESTEIGTED 



feK^he -establishment of this policy is necessary to obtain a regular and stand- 
ardized procedure ■ which will be fully understood by both the Navy and the Red 
Gross.,. , , - --BuMed. Ross T. Mclntire. 

To: All Ships and Stations. BUMED-C-LET 

• : . . _ ^ ^ _ . ■ ET14/A3-1(081-40J : , 

rSiatoj::.-; ; .Coast Qaa:&d Feraomiel -. Medical and ' 1.7 Feb 4 944- . * . - . - • 
Hospital Care by Medical Department 
. of the Navy. ... 



1. Fursuaiitto an agreeifnent entered into between the Coast Guard and the Navy, 
the .following: directives; regarding medical treatment and hospitalization of 
Coast Guard personnel were p\jbj!,iglj8d, to the naval service by BuPers. CircLtr. 
No, 150-41, 9 December 1941: . • : , 

• ;(a3 Eublic Healtii ServlM asdical officers now on duty in Coast .Guar^- 
vessels and at Coast Guard stations will be retained in service. 

Cb) Naval hospitals are available and will be used for hospitalization of all 
Coast Guai*d personnel in an emergency. In general, however. Coast Guard men 
serving in local defense or naval district forces will be sent to Public Health 
Service hospitals if available, while Coast Guard men, serving in seagoing ves- 
sels will be sent to naval hospitals.. ,. - - 

(c) Personnel discharged from naval hospitals will, if practicable, be re- 
turned to vessels from which received, otherwise to be transferred. to the near- 
est Coast Guard district officer for duty. 

(d) When Coast Guard personnel. are .transferred (from vessels lOr stations;^ 
outside continental United States) to naval hospitals, their records and pay ac- 
counts will accompany them or be transmitted as soon as practicable. (The 
pay accounts and records of Coast Guard personnel transferred to naval hospi- 
tals- from shore activities in the United- States will be retained at the -Coast 
Guard" activity from which such personnel are transferred.) 

2. It appearing, however, that the existing relationship between the Navy and 
the Coast Guard with respect to medical and hospital care is not fully imder- 
stood, the following instructions are issued to. supplem©iit.^d interpret the/ 

^/above: . ■ 

3. The medical, dental, and hospital facilities of the Navy are available for 
care and treatment of Coast Guard personnel on active duty whenever and 
s1i6fherever required, and should be employed interchangeably with the medical 



- 19 - 



Burned News Letter, Vol. 3, No. 7 



RESTRICTED 



and hospital services of the Public Health Service (Public Health relief stations 
and Public Health (marine) hospitals) to afford maximum aid to the sick and in- 
jured of the Coast Guard and restore them to duty at the earliest possible date. 
If the facilities of the Public Health Service are more readily available, and 
are adequate for the need, they should be used, but this same policy of ready 
availability should apply equally in the use of Navy facilities. 

4. Coast Guard personnel will be admitted to out-patient, in-patient, or hospi- 
tal care in the facilities of the Medical Department of the Navy, afloat or ashore: 

(a) On request of the individual's commanding officer or other recognized 
superior, or, in the case of detached personnel, on the request and identification 
of the individual. The request may be on NavMed Form G (Hospital Ticket), 
Coast Guard Form 2522 (Application to the U. S. Public Health Service for Re- 
lief for the Personnel of the U. S. Coast Guard), or by letter. An original ver- 
bal request is to be confirmed in writing. 

(b) On admission, Coast Guard personnel will be regarded as supernum- 
erary patients. From continental stations (including all activities in the 13th, 
14th, and 15th Naval Districts) the following reports are required to be submitted: 

(1) Hospitalization or in-patient care in naval hospital or dispensary: 

Forward monthly report in qulntuplicate required by paragraph 3508,' 
ManMedDept, and paragraph 15, Bu. Circ. Ltr. F, Subject: Supernumerary Pa- 
tients, Appendix D, ManMedDept. For fiscal year 1944, per diem patient charge 
is $4.25, which reimbursement is effected by BuMed. Forward Federal Security 
Agency, U. S. Public Health Service (June 1941), completed Form 1971 F to the 
Surgeon General, U. S. Public Health Service, in the case of each Coast Guard 
hospitalized. If forms are not on hand, they may be obtained by requesting same 
from the Public Health Service, Washington, D. C. , Bethesda Station. 

(2) Out-patient examination, treatment, etc., reports: 

At present there is no charge for out-patient service and treatment 
of Coast Guard personnel and no report of such examinations or treatment is 
required by this Bureau or Coast Guard Headquarters. However, necessary en- 
tries shall be made in the health record of each individual treated or examined. 

(3) When indicated, a monthly summary of dental treatment adminis- 
tered to Coast Guard personnel shall be submitted by the rendering naval activity 
in the form of a supplementary NavMed Form K, marked '*C.G." above the head- 
ing. 

(c) The report of death required by articles 908 and 1513, Navy Regulations, 
1920, shall be despatched to SecNav. Certificate of Death (NavMed Form N) shall 



- 20 - 



a:4r.ia'-::^ ^"^^-^^ h^Vl>:.m' ^r'^^-J r^jtsci RESTRinTF.n 

be prepared in quintuplicate, 4 copies to be sent to Head9uart©J!% il|-<^&ifdj 
one copy to BuMed as in the case of Qtfei€^^,^iipeiEf)«i^@^^ . " 

(jJI Reports to Coast Guard. 

(1) From all ships and all stations outsifi^' qplMjI^^i^ except 
stations in 13th, 14th, 15th Naval Districts* 

- The only report required in connection with hospitalization of Coast 
Guard personnel is the Individual Statistical Report of Patient (NavMed Form Fa) , 
which shall be completed in each case in accordance with the instructions appli'* 
cable to naval personnel and forwarded direct to Coast Guard Headquarters, 

Washington, D. G. The completion of these statistical cards and proper entries 
iprjtit^: Ihealth records Is of utmost importance both to the Government and to the 

individual and should receive first attention from those charged with the custody 
of the health records of the personnel concerned. Subsistence charged for of- 
ficers hospitalized shall be collected locally and proper receipts furnished. In , 
case of enlisted personnel of the Coast Guard, the rations furnished shall be re- 
ported on separate Ration Memoranda (NavS&A Form 27). 

_.C2) From contiijental stations and stations in 13th, 14th, and 15th 
N£tval,5^l@|lFicts. •;• r ... . , •. ,-. 

Ca) To Coast Guard Headquarters,, Washington, D. C. 

»io;.r5 -NavMed Form Fa (Individual Statistical Report of Patientt. 

r^'sP.iC Original and 3 copies Navj^fi.p-girm Ip^ iR-^i^ of 
Coast Guard personnel." ' . 

(b) To commanding officer of patient. 

: . -•■ Copy of NavMed Form Fa (Individual Statistical Report of Patient). 
Original and 3 copies NavMed Form M (Report of Medical Survey) . 
Forward to Headquarters, Coast Guard, via the commanding offi- 
,\ : ^xr::;,:<^er'«f ^%Piin?^^ or via t^tetafltt Coast 

/•:v( ;:o bei' Guard offi!^i^j|| ^^^^^^feplfl'li^j^iill^ naval hqsp4k|^,lf 
' ' located. . . - ■ ■ . . 

j5w?piia#t''0u&M-f a*i©tits--i& who ars-psychotid and In need of in- 

stitP-tional care may be transferred to St. Elizabeths Hospital, Washii^on, D.C., 
or to the Public Health Service Hospital, Fort Worth, Texas, in the same manner 
as members of the naval service. Transportation requests either should be issued 
byith^ Coast- 'Guard activity, or if Navy transportation requests are used such re- 
quests should bear notation that the cost thereof is charigeable;ibojt^f ga^^ 
propriation ''Pay and Allowances, Coast Guard." 



- 21 - 



Burned News Letter, Vol. 3, No. 7 



RESTRICTED 



6. Disposition of the dead, (a) When deaths of Coast Guard personnel occur in 
ships or stations of the Navy, or where it is necessary that the Navy, acting for 
the Coast Guard, shall assume control of the situation, unless Coast Guard au- 
thority directs otherwise, the care, transportation, and/or burial of the dead 
shall be arranged in the same manner as for Navy dead, but all expenses shall 
be billed to or reimbursed by the Coast Guard, and all reports shall be trans- 
mitted to that activity (1 copy NavMed Form N to BuMed) . Vouchers drawn in 
payment for such services shall show the appropriation ''General Expenses, 
Coast Guard^' current at the time the expenditure is incurred as the appropria- 
tion chargeable. Such vouchers shall be forwarded to the Commandant, U. S. 
Coast Guard, for payment. 

(b) Whenever possible, the Coast Guard (the command to which the deceased 
was attached, if practicable; otherwise, the Commandant, Coast Guard) shall be 
called on to notify the next of kin of the death and obtain all required instructions 
for disposition of the body. The Coast Guard, in all instances, should be required 
to take charge of or issue instructions for disposition of the personal effects of 
the deceased. ■ 

(c) Where Navy contracts are available they shall be used for Coast Guard 
dead. Invoices received for such services shall be vouchered showing the cur- 
rent appropriation "General Expenses, Coast Guard" as the appropriation 
chargeable. The voucher, when complete, should be forwarded to the Comman- 
dant, U. S. Coast Guard, Washington, D. C. for settlement. If the body is to be 
shipped accompanied by escort, the transportation request either should be issued 
by a Coast Guard activity or, if Navy transportation requests are used, such re- 
quests should bear notation that charges are payable by the Coast Guard and 
chargeable to the appropriation ''General Expenses, Coast Guard.'' Similarly, 

if the body is to be shipped by express, the bills of lading shall specify that the 
carrier is to bUl TJ. S. Coast Guard, Washington, D. C. Bill of lading shall bear 
notation that the charges are payable from the appropriation "General Expenses, 
Coast Guard." Navy standard caskets, for which reimbursement would be re- 
quired, shall be used only in emergency. 

7. Navy Medical. Department equipment stnd supplies; issue and accountability. 
BuMed will furnish medical and dental equipment and supplies carried on the Navy 
Medical Medical Supply Catalog to Coast Guard activities, both ashore and afloat, 
including new construction and expansion, without charge to the Coast Guard. 
However, issue of such material will be subject to the same current instructions 
applicable to naval activities under similar circumstances. In this connection, 
attention is particularly invited to the following: 

(a) Only those items listed in the Medical Department Supply Catalog will 
be supplied by this Bureau. 



- 22 - 



Burned News Letter, Vol. 3., No. 7 



RESTRICTED 



(b) Coast Guard activities are required to submit NavMed Form 4 requisi- 
tions in accordance with instructions contained in Commandant, U. S. Coast 
Guard, letter of 9 December 1943 (CG-423-(PM)). . 

ic) Naval Medical Department activities are authorized to make emergency 
issue of medical supplies (expendable items) to Coast Guard vessels upon re- 
ceipt of the prescribed letter request. Such issues are subject to the approval 
of the issuing activity. Items issued should be invoiced on NavS&A Form 71 
or 127 which shall be receipted by the receiving activity. A signed copy of such 
voucher shall be submitted to BuMed by the issuing activity (BuMed Itr, 
A4-l/Q^13(023), dated 13 Apr 1943). As the items issued are to be transferred 
without reimbursements, notation to that effect should be made on the invoice 
forms. — 

(d) It is pointed out that certain material (paragraph 3048, Manual of the 
Medical Department) needed in medical spaces, both on board ship and ashore, 
is provided by other Navy Department bweaue. To this extent> and as further 
modified by current instructions, issue of such, material is not autitorized by 
tbe pipQ'^^isions of this letter. 

8v The- above Instyustionp hme been approved by the Coast Guard. 

--BuMed. Ross T. Mclntire,. 

J . sfe 3fe 3ft s(c s^c 5|c 

To: All Ships and Stations. ■ ' BUMED-T-RLJ 

P3-l/A16-l(011) 
Subj: Human Plasma, Distribution 29 Feb 1944 

and Use of. 

' ' I ' * ' " . . , '"i' 
Ref: (a) BuMed Form Ltr No. 1, dated 1 Jul 1941. 

1. Quantities and units of dried human plasma, as indicated in reference (a), 
are now oirtdafced. - ■ ■ ' 

2. Experience has shown that many cases need multiple units of plasma. Therefore 
to facilitate its use the Bureau has adopted a 500 c.c. unit to replace the 250 c.c. 
unit. 

3. This item has been added to the supply catalog as follows: 

Stock No. Item Unit 

Sl-3531 Plasma, Normal, Human (500 c.c. Pkg. 

original Plasma: Gomplet%;||ij0iqtiQn _ , , r: 
. assembly with diluent) ,-:.-:L:-3d7b '.;riJ •..•1 .ic^i'-.-.r . 

4. Dried plasma will be issued to ships, to the Fleet Marine Force, tod to 
activities outside the continental limits of the United States. 



- 23 '- 



Burned News Letter, Vol. 3, No. 7 RESTRICTED 



5. In general, quantities requested will be estimated as follows; 

(a) Ships (except APA's): 5 units for every 100 of the ship's complement. 
(Tenders should include the complements of the ships they serve.) 

(b) A.P.A.'s and B.B.'s: 10 units for every 100 of total of crew and troops. 

(c) Hospital Ships: The initial allowance is 500 units. 

(d) Fleet Marine Force: 15 units for every 100 officers and men. 

(e) Hospitals outside of the continental limits and advance base components: 
One unit per hospital or dispensary bed. 

6. A questionnaire accompanies each package of plasma. This shall be filled 
out immediately after using the plasma and returned to the address given on 
the form. 

7. Especial attention is called to the fact that dried plasma is not issued to con- 
tinental shore activities. Units of citrated plasma may be obtained from National 
Naval Medical Center (Naval Medical School) , Bethesda, Maryland, on letter re- 
quest. 

8. Medical officers should familiarize themselves with the current medical 
literature as to the indications for the use of plasma and its dosage. 

--BuMed. Ross T. Mclntire. 

>(; * =j< + >): Jf: 

To: All Ships and Stations. BUMED- Y-AFR 

A2-11/EN10 

Subj: Dysenteries, Diagnosis and Treatment. 6 Mar 1944 

Refs: (a) ''Notes on Tropical and Exotic Diseases of Naval Importance", 

U. S. Naval Medical School, National Naval Medical Center, Bethesda, 
Maryland (August 1943) . 

(b) BuMed Itr B-DLY-A2-11/EN10, dated 13 Nov 1942. 

1. Ref (b) is herewith cancelled. 

2. Attention of all medical officers is Invited to Ref (a) . This pamphlet contains 
in condensed form the latest ideas and instructions concerning diagnosis and 
treatment of tropical diseases. The intention of this letter is to invite particu- 
lar attention to the dysenteries frequently or commonly incident to troop opera- 
tions in tropical countries. 



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: .- ; BumQd l^§ws Letter,,^, ^9^^ 3^_lgo.^ Z__^^^^ RESTRICTED 

3. In order to reduce, the occurrence of diarrhea and dysentery aboard ship 
and among troops operating on shore, it is of utmost importance that medical 
officers diagnose these diseases promptly and correctly, and apply the cura- 
tive Vemedies now available. 

4. Laboratory means of diagnosis of both bacillary and amebic dysentery are 
often not available on ships or in combat zones ashore. ' It, therefore, frequently 
becomes necessary to make the diagnosis on epidemiological and clinical fea- 
tures, niia •■b.y--fe^e"ms^; Of specific drugs. For this purpose, it is particularly 
important. to keep, iu mind and observe J^.|9l|owi&g |ea1^^^ ^.y^,,, r.c.prn'. - ■ ^ 

(a) Bacillary dysentery is by far more common than ^'mebic dysentery. 
Even in areas where dysenteries and^dlar:pheas are very .G,(^ipci|3ao|3j,^I^^^ 10 
per cent are of amebic origin. 

(b) Bacillary dysentery is epidemic; amebic dysentery sporadic. Whenever 
an epidemic of dysentery or diarrhea breaks out, it should be assumed that it 

is of bacillary, rather than amebic, origin. Under conditions of very g^oss 'f eca,l 
pollution of food or water, the frequency of amebic dysentery may, however, 
approach epidemic proportions but this is rare. Outbreaks^of so-caLled food 
poisoning caused by the Salmonella' and other ' group^''6-f drganlims must'bekept 
in mind, but they are usually readily recognized on their diagnostic relation to' " 
the .infftiEtlom ol thaihfected food. ■ . ; ., : - 

(c) Bacillary dysentery, when severe, is a prostrating disease associated . 
with high fever, leukocytosis, and severe toxic effects, "Amebic dysentery on 
the other hand, even though severe with 15 to 20 bowel movements a day, is 
usually a "walking dysentery'/ associated with relatively .mild cqn^titjitional , , 
symptoms. • .^,,t: 

(d) The stools of bacillary dysentery are mostly serosanguineous pus with 
albuminous odor, while the stools of amebic dysentery consj.st, of a tqi4-.S?P,ellifig 
mixture of feces, blood, and brownish, jelly-like mucus. ^ - 

(e) Should .the above features riot appear sufficiently diagnostic, the thera- 
peutic test by emetine should be resorted to without delay or hesitancy. Emetine 
hydrochloride, 0.06 gram (1 grain), should be given subcutaneously on 2 succes- 
sive days. If amebic in nature, there will be a striking improvement witMn 24 ' 
to 48 hours so very apparent to both the patient and medical office'r'that its rec- 
ognition can hardly be overlooked. For practical purposes, lao. excerptions to 
this diagnostic effect of emetine need to be considered. !r...',r^..r, . 

5 . Effeelive and curative .r@mf5di.es,., for .both-bacillary ,and ameb^ic dysentery m&. 
now available. -.- ■■ .. . . ..- = .-m^- r. 



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Burned News Letter, Vol. S, No. 1 ■ RESTRICTED 



(a) Bacillary dysentery. ■ ' 

(1) Sulfadiazine is the drug of choice, with sulfathiazole as second. 
Thedi|itial dose of. both of these drugs is 2.0 grams {30 grains), followed by 1.0 
■grarn'"<l5 grains) " -every six (6) hours until symptoms subside, or until two suc- 
cessive stool cuittirea are negative. The Flexner strain of organism responds 
so well to' the above drugs in the dosage indicated that not infrequently the above 
reccawmended dose can be reduced to one-half (1/2). Occasionally some cases, 
especially those, due to the Sonne strain, develop a resistance to all of the sul- 
fona^nides with the erxceptlon of sulf asuxidine , If response is poor after the 4th 
or 5tli day's treMmelat with other sulfonamides, a change to sulfasuxidine is in- 
dicated. While taking these drugs, it is important that an adequate water intake 
be mMntained'-to- prevent kidney damage. 

(2) Sulfagiianidine was formerly recommended for treatment of bacil- 
lary dysentery, but subsequent studies have shown it to be so insoluble that nine - 
tenths (9 /lO) of the drug passes unchanged through the bowel in crystalline form. 

(3) In severe cases, fluid intravenously is usually required to relieve 
dehydration. Plasma or blood should not be given until dehydration is completely 
relieved. 

(4) Antitoxic serum for Shiga infections is now available on the Supply 
Catalog, Medical Department, U. S. Navy. It is monovalent and should be used 
only when the Shiga bacillus (Shigella dysenteriae) has been shown to be the etio- 
logical agent. Dose: 40-80 c.c, repeated daily until the toxemia and dysentery 
abate. It may be given intramuscularly into the buttocks or intravenously. If 
the latter route is used, serum should be given slowly in 500 c.c. of normal sa- 
line. 

(5) To relieve the abdominal pain and insure rest, camphorated tinc- 
ture of opium, codeine, or morphine should be given. 

(6) Vitamins, particularly B and C, should be given freely to replace 
the loss incident to the disease, to hasten recovery, and to strengthen resistance 
against recurrences. 

(b) Amebic dysentery. 

(1) Give emetine hydrochloride, 0.06 gram (1 grain), subcutaneously 
once a day for 5 days. 

(2) Beginning on third day of the emetine therapy, give carbarsone, 
0.25 gram, by mouth 3 times a day for 7 days. 



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Brnned News Letter, Vol. 3, No. 7 



RESTRICTED 



(3) After an interval of 7 days, give vioform, 0.25 gram, or pulvis 
chiniofoni (yatren),! gram (15 grains), by mouth 3 times a day for 7 days. 

(4) After another interval of 7 days, repeat the course of carbarsone, 
0.25 gram, 3 times a day for 7 days. 

Note 1: When no gastrointestinal irritation or other toxic effects of 
these drugs develop, the interval between the courses may be shortened or 
eliminated. 

Note 2: Diodoquin (Searle) now appears in the Army Medical Supply 
Catalogue, but as yet has not been placed on the Supply Catalog, Medical Depart- 
ment, U. S. Navy. It is related chemically to vioform. When vioform or pulvis 
chlniofoni (yatren3 is not available, diodoquin can be substituted for these drugs 
-following the first course of carbarsone, and the second course of carbarsone 
can be omitted. When used to replace vioform or yatren give diodoquin, 0.6 
gram (9 grains), three times a day for 20 days. 

(c) Amebic Abscess. 

(1) In the presence of amebic dysentery, amebic abscess of the liver 
must be kept in mind. With typical symptoms this complication can usually be 
readily recognized but frequently the clinical picture is obscure, with such in- 
definite symptoms as a run-down condition, loss of weight, some fever, and 
perhaps slight pain over the liver. 

(2) Emetine is a specific for amebic abscess. Give emetine hydro- 
chloride, 0.06 gram CI grain), subcutaneously daily for 8 to 10 days. If neces-' 
sary and if toxic effects (chiefly myocardial damage) do not preclude, repeat at 
intervals of 15 to 20 days. When 6 doses of emetine have been given, start treat- 
ment for eradication of the parasite in the intestines by means of carbarsone 
and vioform as outlined. 

(3) Aspiration may be required for large abscesses; open operation 
must be the last resort. --BuMed. Ross T. Mclntire. 

if: j|c * * + * 



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